Hawaii Medical Service Association* | HMSA Platinum HMO

HMSA Platinum HMO is an Obamacare health insurance plan offered by Hawaii Medical Service Association* that is available for individuals and families.

This plan is a HMO, meaning you will have to stay within the insurance company’s network, and will need to see a primary care doctor first and get a referral in order to see a specialist. (Read more about HMOs.)

This plan is a Platinum metal level plan, which has the highest monthly cost, and for that cost provides the highest coverage (in terms of lowest deductibles and co-pays). Platinum plans are best for those who expect to use their health care benefits a lot throughout the year.

Deductible amount of No Charge. A deductible is the amount of healthcare costs you will pay on your own each year before the insurance company.

Max out-of-pocket of $7,150, which is the most you will pay in a plan year outside of premiums, out-of-network providers and non-essential health benefits.

Plan Summary

Who is this plan for?

This plan with a higher monthly cost is great for individuals and families who have multiple, serious, or chronic health needs, regularly visit the doctor, and regularly use multiple prescription drugs. The low deductible on this plan means you won't have to pay as much money out of pocket for medical care and prescriptions before your insurance kicks in. The very high out-of-pocket maximum on this plan means you could be faced with a very expensive medical bill if an emergency happens. Plans with this type of provider network tend to have a narrower provider network.

HealthCare.com is a privately-held website for healthcare consumers operating since 2007. We’re not the government marketplace.

Highlights

Emergency Room:

$250

Retail Drugs:

$30

Generic Drugs:

$7

Overview

Plan Type:

HMO

Metal Level:

Platinum

Health Spending Account:

No

Primary Care Office Visit:

$10

Specialist Office Visit:

$20

Out of Network Coverage:

Yes

Out of Country Coverage:

Yes

Coverage Details

Preventive Care

Periodic Health Exam

In Network:

No Charge

Out of Network:

Not Covered

Well Baby Care

In Network:

No Charge

Out of Network:

Not Covered

Inpatient

Hospital Services

In Network:

$300 Copay per Day

Out of Network:

Not Covered

Physician Fee

In Network:

10%

Out of Network:

Not Covered

Skilled Nursing Facility

In Network:

$300 Copay per Day

Out of Network:

Not Covered

Mental Health

In Network:

No Charge

Out of Network:

Not Covered

Substance Abuse

In Network:

No Charge

Out of Network:

Not Covered

Home Healthcare

In Network:

10%

Out of Network:

Not Covered

Outpatient

Surgery

In Network:

10%

Out of Network:

Not Covered

X-ray and Diagnostics

In Network:

$10

Out of Network:

Not Covered

Labs

In Network:

$10

Out of Network:

Not Covered

Facility Fee

In Network:

20%

Out of Network:

Not Covered

Mental Health

In Network:

$10

Out of Network:

Not Covered

Substance Abuse

In Network:

$10

Out of Network:

Not Covered

Rehabilitation Services

In Network:

$10

Out of Network:

Not Covered

Maternity/Pregnancy

Pre & Postnatal Care

In Network:

10%

Out of Network:

Not Covered

Infertility Treatment

In Network:

10%

Out of Network:

Not Covered

Labor and Delivery Inpatient Services

In Network:

10%

Out of Network:

Not Covered

Dental

Accidental Care

In Network:

10%

Out of Network:

Not Covered

Vision

Eye Exam (Child)

In Network:

$10

Out of Network:

50%

Glasses (Child)

In Network:

$25

Out of Network:

50%

Additional Coverage

Chiropractic Care

In Network:

$20

Out of Network:

Not Covered

Habilitation Services

In Network:

10%

Out of Network:

Not Covered

Rehabilitation Services (Speech)

In Network:

$10

Out of Network:

Not Covered

Rehabilitation Services (Occupational Therapy)

In Network:

$10

Out of Network:

Not Covered

Hospice Service

In Network:

No Charge

Out of Network:

Not Covered

Diabetes Care Management

In Network:

No Charge

Out of Network:

Not Covered

Durable Medical Equipment

In Network:

10%

Out of Network:

Not Covered

Hearing Aids

In Network:

10%

Out of Network:

Not Covered

Nutritional Consuleling

In Network:

No Charge

Out of Network:

Not Covered

Reconstructive Surgery

In Network:

10%

Out of Network:

Not Covered

Doctor Visits

Primary Care Visit

In Network:

$10

Out of Network:

Not Covered

Specialist Visit

In Network:

$20

Out of Network:

Not Covered

Other Practitioner Office Visit

In Network:

$10

Out of Network:

Not Covered

Preventative Care / Screening / Immunization

In Network:

No Charge

Out of Network:

Not Covered

Emergency Room and Urgent Care

Emergency Room Services

In Network:

$250

Out of Network:

$250

Urgent Care Services

In Network:

$20

Out of Network:

Not Covered

Ambulance/Transportation Services

In Network:

10%

Out of Network:

Not Covered

Drugs

Generic Prescription

In Network:

$7

Out of Network:

$7 then 20%

Retail Brand Drugs

In Network:

$30

Out of Network:

$30 then 20%

Non Retail Brand Drugs

In Network:

$75

Out of Network:

$75 then 20%

Specialty Drugs

In Network:

20%

Out of Network:

Not Covered

Additional Plan Information

HealthCare.com is a privately owned website, and monthly costs shown above are estimates only.
Your monthly premium may change based on the data provided, outside fees, optional benefits
or if other factors take effect before your coverage start date. Note that insurance companies
reserve the right to change your premium rate and the policy terms at any time. Effective date,
benefit amounts and other conditions may apply at the discretion of the insurance carrier you select.
Depending on your state of residence, this website may not display all plans available by state.
The Obamacare Tax Subsidy Calculator amounts are estimates only and the actual amount of subsidy
eligibility may differ. Access to your physician depends on network selected, and networks can
change without notice. Contact your health insurance company to confirm your healthcare provider
is still available in the network you select.